WS-02-19-417 CanceledMiami Shores Village � Vr
Building Department FE 22 `::'.�
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
BY: ut`
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING CANCELLEDMasterPermit No. M— Li -Zoo I
PERMIT APPLICATION Sub Permit No. WS-2-Iq—II_I
QBUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ORENEWAL
WIN 0 •Wf
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1514 NE 105th St Miami Shores FL 33138
City: Miami Shores County: Miami Dade Zip
Folio/Parcel#: 11-2230-053-0290 Is the Building Historically Designated: Yes _ NO NO
Occupancy Type: MF Load: Construction Type: Con. Slab Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Brent Latham
,,t,,„«. 7521 Beach View Drive
City: North Bay Vi
Tenant/Lessee Name:
Email: brentwlatham@gmail.com
State: FL
CONTRACTOR: Company Name: Bryan Latham
Address: 3187 Via Abitare Way
City: Miami State: FL
3059514287
33141
917 549 9635
33133
qualifier Name: Bryan Latham Phone#: 917 549 9635
State Certification or Registration #: CBC1262598 Certificate of Competency #: 917 549 9635
DESIGNER: Architect/Engineer: Bryan Latham Phone#:
Address:3187 Via Abitare Wady rtr� Cif,: Miami State: FL Zip: 33133
Value of Work for this Permit: y 6 iY.)(''j Square/Linear Footage of work: '211 F30
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Workk:���• Windows, Doors,-WaRabiug,_an
s9EweteFal,-fe44ionr4eef,+h er do u`M W S ` 2 &0 +' 3
Specify color of color thru tile:
Submittal Fee $ � t A Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR$ Notary:
Double Fee $,
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. A
Signature
Signatu
OWNER ar AGENT
The foregoing instrument was acknowledged before me this
The for
20 19 , by
—Q N— dday' of�,,'�4
2— �
_�4
SJYV 4—atfli M who is personally known to
61 0�
me or who has produced
and who did take an oath.
Sign:
Print:
Seal:
IYIII,
aµ
APPROVED BY
(Revised02/24/2014)
Art
GRACIELA MARIOT
Notary Public • State of Florida
Commission 8 GG 036739
foing instrume t was acknowledged before me this
dayof MFUCkVLJ 2D 161by
n
as me or who has produced
identification/anidentification/anlo who did tTke an
Print:
Seal:
Plans Examiner
Structural Review
V YANADYPRIETO
MY COMMISSION s FF 214031
EXPIRES: March 25, 2019
known to
as
Zoning
Clerk